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Impact of adrenalectomy on 5-HT6 and 5-HT7 receptor gene expression in the rat hippocampus.

Both glucocorticoid excess and decreased serotonergic (5-HT) transmission may cause depression. The recently cloned 5-HT6 and 5-HT7 receptors have high affinity for antidepressants. Here, we show that pharmacological adrenalectomy increases 5-HT6 and 5-HT7 receptor mRNA expression in specific hippocampal subfields, effects partly reversed by corticosterone replacement. Increased 5-HT6 and 5-HT7 receptor expression may provide a basis, in part, for the therapeutic actions of adrenal steroid synthesis inhibitors in resistant depression.

Adrenalectomy↗

Prevention of ACTH- and adrenalectomy-induced muricidal behavior: by benzodiazepinic ligands.

We investigated the effect of treatment with central (neuronal and glial) benzodiazepine binding site-active molecules on ACTH- or adrenalectomy (ADX)-induced muricidal behavior in male Wistar rats. Pretreatment (IP) with either flumazenil or clonazepam prevented the subsequent induction of ADX-induced behavior, but only flumazenil protected against ACTH-induced behavior; posttreatment in both cases induced no significant modifications. Using 4'-chloro-diazepam or PK 11195, both pre- and posttreatment afforded protection, the effect lasting longer (> 1 week) than that induced by flumazenil or clonazepam (2 days). Pretreatment with the GABAA agonist, muscimol, also resulted in complete protection, whereas posttreatment had only a slight effect.

Adrenalectomy↗

[Laparoscopic adrenalectomy].

Laparoscopic extirpation of the suprarenal gland is considered the 'gold standard' of surgery for benign conditions, but its indication in suprarenal cancer is still controversial. In this article, we review the pros and cons of the laparoscopic approach in the different disorders that affect the adrenal gland, pheochromocytoma, cancer, partial and bilateral adrenalectomy, etc.

Adrenal Gland Neoplasms↗

Cushing's syndrome during pregnancy: curative adrenalectomy at 31 weeks gestation.

A case of Cushing's syndrome due to benign adrenal adenoma (Ad) arising in pregnancy is described. Accurate tumour localisation with magnetic resonance imaging facilitated definitive surgical intervention. Curative adrenalectomy was performed via a posterior approach in the third trimester with subsequent uncomplicated delivery of a healthy infant.

Adenoma↗

Effects of adrenalectomy and corticosterone replacement on diurnal [3H]citalopram binding in rat midbrain.

Corticosteroids modulate the expression and/or functions of several serotonin (5-hydroxytryptamine; 5-HT) receptors. Conversely, analyses of the effects of corticosteroids upon 5-HT reuptake systems have been scarce and contradictory. Herein, the diurnal rhythm of midbrain [3H]citalopram binding to 5-HT transporters was analysed in sham and 11 day adrenalectomised rats. In addition, adrenalectomised rats were either complemented or not with corticosterone pellets (12.5-200 mg). Analyses of body weight increases and plasma adrenocorticotropic and corticosterone levels indicated that the protocol allowed the stimulation of mineralocorticoid receptors (MRs; 12.5 mg pellets) or the stimulation of both MRs and glucocorticoid receptors (GRs; 50-200 mg pellets). However, besides the observation of a slight, but significant diurnal (corticosteroid-independent) rhythm in 5-HT transporter binding (morning > evening), it was found that neither adrenalectomy nor corticosteroid receptor stimulation affected midbrain [3H]citalopram binding.

Adrenalectomy↗

The daily pattern of Fos synthesis by hypothalamic pro-opiomelanocortin neurons is unaffected by adrenalectomy in the rat.

At the onset of dark, a large population of rat mediobasal hypothalamic (MBH) pro-opiomelanocortin (POMC) neurons starts spontaneously expressing Fos-immunoreactivity (Fos-IR). Here we studied the effect of adrenalectomy upon this expression since circulating corticosteroids, which increase in the rat with the onset of behavioural wakening, are thought to modulate the basal expression of MBH POMC mRNA. Hence, groups of intact, adrenalectomised and sham-operated rats were sacrificed at times when Fos synthesis by POMC neurons is known to show either nadir (at light-offset) or peak (6 h after light-offset) values. Brains were processed for Fos- and/or POMC immunohistochemistry. This allowed us to show that, in all experimental groups, Fos-IR is hardly expressed in MBH POMC neurons at the onset of dark, whereas it is strongly induced 6 h later. We concluded that such an induction is not triggered through the known evening rise of plasma corticosteroid levels.

Adrenalectomy↗

[Laparoscopic adrenalectomy for pheochromocytoma. Perioperative blockade with urapidil].

OBJECTIVE: To investigate the effects of coeliosurgery by catecholamine assays and the use of urapidil in the management of phaeochromocytoma. STUDY DESIGN: Prospective cohort study. PATIENTS: Nine consecutive patients from April 1997 to April 2001. METHODS: Urapidil (250 mg.j-1) was administered by continuous intravenous infusion three days before surgery and continued throughout anaesthesia. Plasma catecholamine concentrations were measured before surgery, after induction of anaesthesia, during insufflation, after adrenalectomy and in the recovery room. Haemodynamic disorders were treated by nicardipine +/- esmolol bolus doses. RESULTS: Creation of pneumoperitoneum and adrenal gland manipulations resulted in significant catecholamine releases associated with hypertension in five and eight patients respectively. Preventive urapidil use enabled easy control of blood pressure variations by additive antihypertensive drugs. CONCLUSION: Perioperative alpha 1 blockade by urapidil enables an effective and easy control of acute preoperative haemodynamic changes.

Adrenal Gland Neoplasms↗

Transperitoneal anterior laparoscopic adrenalectomy: the easiest technique.

Four laparoscopic methods have been developed to approach the adrenal gland: anterior or lateral transperitoneal approaches, and lateral or posterior retroperitoneal approaches. The advantages and disadvantages of these methods were reviewed during a workshop held by the Japanese Society of Endourology and ESWL in 1997. The transperitoneal anterior approach, when combined with a lateral approach for the left side, is the easiest for small adrenal tumors, and discloses the adrenal vein early in the procedure. For large tumors over 5 cm in diameter, the transperitoneal lateral approach is the most feasible bilaterally. Regardless of the methods of approach, laparoscopic adrenalectomy has already become the standard procedure for adrenal tumors, because it minimizes the operative morbidity and postoperative hospital stay.

Adrenalectomy↗

Maternal alcohol and adrenalectomy: asynchrony of stress response and forced swim behavior.

Fetal alcohol-exposed (FAE) rats exhibit heightened hormonal and behavioral stress responses, strikingly similar to those caused by exposure to elevated maternal corticosterone (CORT). Since alcohol increases maternal CORT, this study examined the effect of maternal adrenalectomy (ADX) on the CORT stress response and forced swim test (FST) behavior of the adult FAE offspring. Maternal ADX alone dramatically enhanced the CORT stress response of the offspring of pair-fed (PF) mothers but had no effect on the exaggerated CORT response to restraint stress observed in the FAE female. In contrast, maternal ADX reversed the increased immobility of FAE offspring in the FST of depressive behavior. These findings provide original evidence that stress hyper-reactivity and depressive behavior in the FAE offspring are mediated by separate developmental mechanisms.

Adrenalectomy↗

Spontaneous pneumothorax during laparoscopic adrenalectomy secondary to a congenital diaphragmatic defect.

Despite its obvious benefits, laparoscopic surgery is not free of complications. It may cause significant physiologic changes and technical mishaps. Pneumothorax has been described as a complication of almost any type of laparoscopic surgery. We report a case of tension pneumothorax during laparoscopic adrenalectomy secondary to a congenital diaphragmatic defect and describe our treatment.

Adrenalectomy↗

Laparoscopic retroperitoneal adrenalectomy: clinical experience with 120 consecutive cases.

OBJECTIVE: Surgical parameters of laparoscopic retroperitoneal adrenalectomy (LRA) for the treatment of benign adrenal tumours were analysed to report the clinical outcomes and technical guidelines for this operation. METHODS: Operative data from 120 consecutive patients who underwent LRA performed by a single surgeon were reviewed. Patients were categorized into one of four stages according to the major technical modifications made during the development of this procedure: needle insufflation, kidney localization, instrument refinement, and the final stage of finger dissection. The surgical parameters of different stages were evaluated, including operation time, operative blood loss, adenoma size, pathology, surgical complications, morbidity, and postoperative recovery. RESULTS: LRA was an evolving technique; operation time and conversion rate decreased gradually as the technique evolved over the years. Operation time was reduced particularly when finger dissection was used to develop the operative working space. Operation time reached a nadir of 80 minutes for patients with left adrenal aldosteronoma after 40 such cases. The overall conversion rate, regardless of the nature of the tumour, was 5%; phaeochromocytoma had the highest conversion rate (43%). A higher conversion rate and longer operation time were noted in patients with Cushing's adenoma or phaeochromocytoma compared to patients with aldosteronoma. CONCLUSION: LRA proved to be a safe and effective treatment for benign adrenal tumours, with few open conversions except for phaeochromocytomas. Finger-assisted dissection for space development was the major factor leading to shortened operation times.

Adrenal Gland Neoplasms↗

Laparoscopic adrenalectomy for malignant disease.

Malignant tumours of the adrenal gland are uncommon but are associated with substantial mortality. For most tumours resection is the only opportunity for cure. Advances in diagnostic and surgical techniques have improved the detection and treatment of these tumours. Further advances need new ways to make decisions about the use of laparoscopic resection for malignant, or potentially malignant, adrenal tumours. We review studies on the outcome of laparoscopic adrenalectomy for primary adrenal cancer as well as studies on metastatic disease to the adrenal glands. There are few prospective data because of the rarity of this condition. Careful individual judgment by the surgeon remains the cornerstone of safe and complete resection for adrenal malignant disease.

Adrenal Gland Neoplasms↗

Adrenal leiomyoma treated by hand-assisted laparoscopic adrenalectomy: a case report.

A left adrenal incidentaloma was found by abdominal ultrasound and computed tomography (CT) in a 53-year-old woman who had a history of non-insulin dependent diabetes mellitus. Abdominal CT showed a well-circumscribed adrenal mass (5.5 x 4.5 x 3.5 cm) with low density (32HU) on precontrast scan and heterogeneous enhancement on postcontrast scan. Laboratory examinations revealed a nonfunctional adrenal tumor. As the malignant potential of the tumor could not be ruled out, the patient underwent hand-assisted laparoscopic adrenalectomy. Postoperative recovery was uneventful, and pathologic examination revealed leiomyoma.

Adrenal Gland Neoplasms↗

Schizophrenia and Cushing's syndrome cured by adrenalectomy.

A case of Cushing's syndrome in a woman aged 50 years is described, with psychosis of schizophrenic type. The psychosis and endocrine disorder were subsequently cured by adrenalectomy. Twenty-five years previously the patient had a typical schizophrenic psychosis treated in mental hospital with a deep insulin therapy and ECT. The possibility is raised that deep insulin therapy could have induced the Cushing's syndrome through its non-specific stressor effect on the pituitary-adrenal axis.

Adrenalectomy↗

Effects of adrenalectomy on serotonin-, somatostatin-, and gastrin-immunoreactive cells in rat gastrointestinal tract.

The effects of bilateral adrenalectomy on the serotonin-, somatostatin-, and gastrin-immunoreactive cells in the rat gastrointestinal tract were studied four weeks after surgery. Body weight was reduced and the small intestine shorter in adrenalectomized animals compared with controls, while no changes were found in the histology of the mucosa. In the adrenalectomized animals the number of serotonin-immunoreactive cells was increased in the cecum and large intestine, while the somatostatin-immunoreactive cells were decreased in number in the antrum and increased in the corpus, cecum, and large intestine. The gastrin-immunoreactive cells in the antrum were not affected in number, but their nuclear size was enlarged, possibly indicating increased cellular activity.

Adrenal Glands↗

5-HT1A receptor agonist reverses adrenalectomy-induced loss of granule neuronal morphology in the rat dentate gyrus.

Adrenal steroids are important for maintaining neuronal maturation in the adult rats. Two weeks after bilateral adrenalectomy (ADX), hippocampal MAP-2 (microtubule associated protein-2) and calbindin immunoreactivity (IR) decreased in the molecular layer of the superior blade of the dentate gyrus. The molecular and granular cell layer at the lateral tip of the superior blade decreased in width by 32% and 50%, respectively. The granule neurons showed reduced staining with Nissl and an anti-calbindin antibody. These changes suggested a loss of the mature neuronal morphology. In this same localized regions, two glial proteins, glial fibrillary acidic protein (GFAP) and S-100 beta showed dramatically reduced immunoreactivity. These effects induced by ADX were reduced within 72 hrs by ipsapirone (1 mg/kg), a 5HT1A receptor agonist. Loss of adult neuronal morphology by ADX, and reversal by the 5HT1A agonist, may be evidence of the trophic importance of the 5HT1A receptor in granule neurons of hippocampus.

Adrenalectomy↗

Vasopressinergic, oxytocinergic, and somatostatinergic neuronal activity after adrenalectomy and immobilization stress.

Twenty days after bilateral adrenalectomy (ADX) or immediately after the last of three 6-h long immobilization periods, the levels of hypothalamic and neurohypophyseal L-[35S]Cys-labeled arginine vasopressin (AVP), oxytocin (OT), and somatostatin-14 (SRIF) (only stressed animals) were measured simultaneously in male Wistar rats, after third ventricular administration of the labeled precursor, via guide-cannulae. The acetic acid-extracted labeled peptide fractions were purified by two sequential HPLC steps. After a 4 h period of labeling, only L-[35S]Cys-AVP was selectively increased in the hypothalami of ADX-ized rats, compared to the sham-operated animals, possibly reflecting a significant activation of the paraventricular parvocellular (PVC) AVP/corticotropin-releasing factor (CRF) neurons. The increased accumulation of neurohypophyseal L-[35S]Cys-labeled AVP and OT in these animals, without changes in the endogenous levels of these peptides, as measured by UV absorbance, also suggests a moderate activation of the magnocellular (MGC) AVP and OT neurons, as a consequence of adrenal insufficiency. In response to immobilization stress, levels of L-[35S]Cys-OT were selectively increased in the hypothalami and corresponding neurohypophyses, 2 h and 4 h after receiving the label, concomitantly with a statistically significant reduction in the stores of OT in the neural lobes. AVP and SRIF biosynthesis remained unaffected by immobilization; the neurohypophyseal AVP stores likewise remained unchanged. These observations suggest the selective activation of MGC-OT neurons in response to chronic immobilization stress. Selective increases in hypothalamic L-[35S]Cys-AVP in ADX-ized rats, and in hypothalamic L-[35S]Cys-OT in chronically stress-immobilized rats, are presented as a measure of PVC-AVP/CRF and MGC-OT neuronal activation, respectively.

Adrenalectomy↗

Acute corticosterone replacement reinstates performance on spatial and nonspatial memory tasks 3 months after adrenalectomy despite degeneration in the dentate gyrus.

Long-term adrenalectomy (ADX) causes loss of spatial memory and of dentate gyrus cells. These effects are prevented by chronic replacement of corticosterone (CORT). The effects of acute replacement 3 months after ADX in rats classified as ADX or incomplete ADX (INC) on the basis of saline intake, weight, and plasma CORT levels were investigated. ADX rats swam longer and farther to find a platform in a spatial water-maze task (Exp. 1) and were impaired on a nonspatial object-recognition task (Exp. 2) compared with INC and SHAM rats. In both experiments, ADX decreased the size of the dentate gyrus, and replacement with CORT either 5 or 10 days prior to and during testing restored the performance of ADX rats without affecting the size of the dentate. CORT did not affect INC and SHAM rats. Thus, the adverse effects of ADX on memory may not be due to damage in the dentate, and the effects of CORT replacement may operate outside the hippocampus.

Adrenalectomy↗